Antibiotic Resistance Grows as Last-Line Drugs Fail

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While political scenarios facing the world have many people nervous about what kind of future we face, there is a microscopic war that is constantly being waged, and the pathogens that are gaining the upper hand don’t care about affiliations or votes. These microbial marauders are indiscriminate about whom they infect, and their resistance movement is beginning to spread at an alarming rate. This is a global public health crisis that needs to be addressed on multiple fronts, such as drug discovery, improved rapid detection methods, and patient education.

“Antibiotic resistance is one of the most pressing public health issues of our time. If we don't tackle it, we could go back to a time when even the simplest medical operations were not possible, and organ transplants, cancer chemotherapy or intensive care even less so,” explained Vytenis Andriukaitis, M.D., the European Commissioner for Health and Food Safety.

Now, on the occasion of the 9th European Antibiotic Awareness Day, the European Centre for Disease Prevention and Control (ECDC) is releasing its latest EU-wide data on antibiotic resistance and antibiotic consumption. In 2015, antibiotic resistance continued to increase for most bacteria and antibiotics under surveillance, as the EU average percentage of carbapenem resistance in Klebsiella pneumoniae rose from 6.2% in 2012 to 8.1% in 2015, and combined resistance to carbapenems and polymyxins (e.g., colistin) was sometimes reported. These two groups of antibiotics are considered last-line antibiotics because they usually are the last treatment options for patients infected with bacteria resistant to other available antibiotics. While antibiotic consumption in hospitals significantly increased in several EU Member States, antibiotic use in the community decreased in six EU Member States.

"The European Commission will launch a new action plan next year so that we can, together with our partners in the EU Member States and internationally, continue to ensure that the prevention and control of antibiotic resistance is strengthened within a one-health approach,” stated Dr. Andriukaitis.

"Antibiotic resistance in Klebsiella pneumoniae is of increasing concern in Europe,” added ECDC acting director, Andrea Ammon, M.D. “More than one-third of the isolates reported to ECDC for 2015 were resistant to at least one of the antibiotic groups under surveillance, and combined resistance to multiple antibiotic groups was common. Moreover, the emergence of K. pneumoniae infections with combined resistance to carbapenems and colistin is worrisome and an important warning that options for treatment are now even more limited than in the past."

The ECDC's data also showed that antibiotic resistance for Escherichia coli, one of the most frequent causes of bloodstream infections and urinary tract infections, requires close attention as the percentages of isolates resistant to commonly used antibiotics continues to increase throughout Europe. In contrast, the proportion of methicillin-resistant Staphylococcus aureus (MRSA) showed a significantly decreasing trend at the EU/EEA level between 2012 and 2015. Despite this positive development, MRSA remains a public health priority as eight out of 30 countries reported percentages above 25%.

"The decrease of antibiotic consumption in the community in six countries is a positive sign and shows that we are starting to use antibiotics more prudently,” Dr. Ammon noted. “Prudent use of antibiotics is pivotal, both in the community and in hospitals, to ensure that these drugs remain effective.”

“Surveillance of antibiotic resistance is the backbone of our work in defense of antibiotics' effectiveness,” remarked Zsuzsanna Jakab, Ph.D., the World Health Organization (WHO) Regional Director for Europe. “Until we know where resistance is, we cannot prioritize action. This is why we focus on expanding the map of antibiotic resistance beyond the EU countries through the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network. What the report indicates is of concern: Our patients are exposed to resistant bacteria in hospitals due to overuse and misuse of antibiotics and poor infection prevention and control. We urge our leaders to use this evidence and accelerate their response to a major global health threat of our time.”

The ECDC works jointly with the WHO Regional Office for Europe and partners World Antibiotic Awareness Week to promote the prudent use of antibiotics in more than 40 countries across the European region surrounding the European Antibiotic Awareness Day. Moreover, following the success of last year's 24-hour Global Twitter conversation on antibiotic resistance and prudent use of antibiotics around the world, the ECDC coordinated a global Twitter conversation on November 18th, hosted jointly by participating organizations from Australia, Canada, New Zealand, the U.S., the WHO Headquarters, and the WHO Regional Offices. The hashtags that used were #AntibioticResistance and #EAAD2016.